R. C. Deka

Vertigo syndromes and mechanisms in migraine

This paper attempts to define and categorize the vertigo associated with migraine. A retrospective chart review of 344 cases of vertigo identified 19 cases with headaches characteristic of migraine as per strictly defined criteria (International Headache Society, 1988). Four distinct types of vertiginous syndromes were noted. The commonest syndrome (Group I) manifested transient episodes of imbalance with additional momentary subjective rotary vertigo worsened by movement. The attacks lasted a few hours and evaluation in the inter-episode interval demonstrated no vestibular deficit. Group II manifested transient objective rotatory vertigo of from 10 minutes to a few hours but no demonstrable permanent vestibular deficit. Group III displayed symptoms and signs characteristic of benign paroxysmal positional vertigo (BPPV) and Group IV manifested a permanent unilateral labyrinthine weakness. Causation of vertigo by migraine was implied in 10 of 19 cases where the headache and vertigo occurred simultaneously and in two other cases where the vertigo improved with anti-migraine prophylactic treatment. Four distinct and characteristic vertigo syndromes have been noted with migraine. Their spectrum ranges from a transient reversible dysfunction to a more permanent destruction, and includes involvement of both the peripheral and the central vestibular systems.

Nasal septal deviation: Effective intervention and long term follow-up

Nasal septal deviation (DNS) occurs more frequently during childhood although it occurs at any age due to trauma. Recently, it has been increasingly recognized that nasal septal deviation is seen also at birth and a number of explanations for this occurrence is forwarded. Awareness of such occurrence and its recognition at birth both by pediatricians and obstetricians is essential for early interventional management of this condition in close collaboration with the otorhinolaryngologists. Closed surgical intervention of this defect carried out early after it was detected at birth benefitted the afflicted in terms of nasal airway improvement and its maintenance resulting in normalization of its anatomy and physiology in long term follow-up. Septal deviation detected at birth if left alone without interventional procedure continues to persist. It is furthermore accompanied by statistically valied symptoms like upper respiratory infections, cough, earache, ear discharge, fever, mouth breathing and at times feeding difficulty during infancy and childhood. Long term follow-up of children who underwent closed surgical correction of DNS at birth, revealed no untoward effects such as nasofacial disproportion or retardation of facial growth. Early interventional management of DNS detected at birth therefore appears to be a safe procedure. It can even be performed by neonatologists or an obstetrician. Such an intervention procedure early in life can prevent septoplasty surgery at a latter date besides preventing a number of nasal airway-related conditions.

Adjuvant therapy with flutamide for presurgical volume reduction in juvenile nasopharyngeal angiofibroma

Although 2 studies totaling 11 cases have indicated some benefit of anti‐androgen treatment with flutamide on juvenile nasopharyngeal angiofibroma (JNA), it is not part of contemporary practice.

Otorhinolaryngologic manifestations of leprosy

Leprosy is often looked upon with dread because of its propensity to cause deformities and disabilities, with resultant stigmatization, and continues to be an important health problem in several parts of the developing world. According to World Health Organization (WHO) data, at the beginning of 2005, the global registered prevalence of leprosy was more than 286,000, and the number of new cases detected during 2004 was over 407,000. Of these, 47% were multibacillary cases, and 4% had severe disabilities. 1 Full control of leprosy has eluded attempts in many countries including India, Nepal, and Brazil. The causative organism, Mycobacterium leprae , infects mucosal, peripheral neural, and reticuloendothelial tissues. Depending on their immune response to the bacillus, patients present with different clinicopathologic manifestations, namely polar tuberculoid or lepromatous, borderline tuberculoid or lepromatous, mid-borderline, and pure neuritic forms. The most common manifestations of leprosy are hypoesthetic skin patches, cutaneous infiltration, peripheral nerve thickening, and “glove and stocking” sensory loss. Trophic ulcers, paralytic deformities, and resorption of extremities lead to the final picture of the polar lepromatous form of leprosy. Advanced lepromatous leprosy can involve most organs in the body, including structures in the ear, nose, and throat. Fortunately, the more advanced manifestations of otorhinolaryngologic involvement are becoming less common with the widespread use of multidrug therapy, but subtler presentations may be missed if not looked for.

Entomophthoromycosis of the nose and paranasal sinus

A case of entomophthoromycosis of the nose and paranasal sinus is presented. To our knowledge, this is the youngest patient reported with this infection. Though the clinical picture mimicked a malignancy, histopathology clinched the diagnosis of entomophthoromycosis. The lesions resolved completely with oral potassium iodide.

Cochlear implantation in Waardenburg syndrome: The Indian scenario.

Abstract Conclusion: Children with Waardenburg syndrome (WS) exhibiting normal inner ear anatomy, like those included in our cohort, derive significant benefit from cochlear implantation and results are comparable to those reported for the general population of implanted children. Objectives: The patient population of WS accounts for approximately 2% of congenitally deaf children. The purpose of this retrospective case review was to describe the outcomes for those children with WS who have undergone cochlear implantation. Methods: On retrospective chart review, there were four cases with WS who underwent cochlear implantation. These cases were assessed for age at implantation, clinical and radiological features, operative and perioperative course, and performance outcomes. Auditory perception and speech production ability were evaluated using categories of auditory performance (CAP), meaningful auditory integration scales (MAIS), and speech intelligibility rating (SIR) during the follow-up period. Results: In this group of children with WS, with a minimum follow-up of 12 months, the CAP score ranged from 3 to 5, MAIS from 25 to 30, and SIR was 3. These scores are comparable with those of other cochlear implantees.

Heterotopic neuroglial tissue in hard palate

Heterotopic neuroglial condition is a rare congenital anomaly in children. Most of the reported cases have been located in nose. To date, there was no recorded case of heterotopic neuroglial tissue in hard palate without any other congenital anomaly. The purpose of this report is to present a rare case of heterotopic neuroglial tissue in hard palate to add to literature we reviewed.

Proton Pump Inhibitors Versus Solitary Lifestyle Modification in Management of Laryngopharyngeal Reflux and Evaluating Who is at Risk: Scenario in a Developing Country.

Background Laryngopharyngeal reflux disease can present with a varied symptomatology because of the involvement of multiple sub-sites of the upper aero-digestive tract. It is a very common disease to be encountered in routine practice by both medical and ENT personnel. Its association with multiple pathologies including malignancy warrants an early diagnosis and management. The lack of cost effective and non-invasive tests constitutes a major hurdle in its early management. Objectives 1. To define the “at risk” population, prone to developing laryngopharyngeal reflux. 2. To formulate major and minor risk factors for the clinical diagnosis of patients with laryngopharyngeal reflux. 3. To evaluate the efficacy of lifestyle management alone as a treatment option. 4. To formulate a treatment protocol for the management of patients and to prevent recurrence. Study Design We performed a prospective analysis of 234 patients diagnosed with laryngopharyngeal reflux. Patients were randomized into study and control groups based on the treatment protocol, using a computer generated randomization table and were single blinded to the type of therapy received. A complete analysis of the possible risk factors, symptoms, and signs was performed with statistical analysis. Results and Conclusion The data has helped us define the “at risk” population and formulate the criteria to diagnose cases of laryngopharyngeal reflux, clinically. The results emphasize the non-requirement of invasive or costly investigations for all patients and indicate the probable protocol to be followed prior to considering further investigation. The role of long term proton pump inhibitor treatment along with lifestyle modification in the initial phase of treatment, as mentioned in the literature, was re-confirmed by our study. However, in addition to the initial treatment, the study establishes the need for continuing lifestyle modification further for at least six months after the cessation of proton pump inhibitor therapy to prevent early recurrence of symptoms.

Nasal septal deviation at birth and its diagnosis

Nasal septal deviation occurs at all ages. It occurs mostly during childhood due to trauma. It is also seen at birth and during early childhood. Hence awareness of this disorder among the pediatricians, the otolaryngologists, and the obstetricians is important, as it can be detected at the earliest possible and thus can be prevented.

Clinical and whole organ serial section studies on cancer of the larynx and laryngopharynx

The study included one hundred cases of carcinoma of the larynx and laryngopharynx for clinical material and the histological material consisted of seventeen specimens of larynges removed at surgery. Eleven of the cancerous specimens had full radiation before surgery while other six had primary surgery as modality of treatment. Detailed histological assessment was made in them. Both clinical and histological observations were discussed and it was attempted to evaluate ths histological correlates, as observed by whole organ section of the clinical features of the cases. Few conclusions were made in the light of this clinicohistopathological correlation.